1. 460 – Module 2, Winter 2006 Philosophy and Basis for Alt / Comp [ ** Note: there are a few slides with notes below them ]

5. Street Lamp Interference – SLI & SLIders Appliances such as lamps and TVs go on and off without being touched Light-bulbs constantly blow when the SLIder tries to turn them off or on Volume levels change on TVs, radios, and CD players Watches stop working Children's electronic toys start by themselves when the SLIder is present Credit cards and other magnetically encoded cards are damaged or erased when in their possession Mind-Body Medicine implications re chapter 3

6. ancient Egyptian vaginal speculum

7. Historical Background & Precedents re Health-Medicine Flexner Report of 1910 Cited as THE most important event in the history of Cdn and American med educ Abraham Flexner was sec school teacher who went on to do grad work in educ research w Carnegie Foundation

8. Historical Background & Precedents Report was effort to reform med schools that were without standards and more for-profit than educ Virtually guillotined all other forms of med ed toward German tradition of strong biomed sciences and hands-on clinical tr Thus in N America, western medicine flourished, trad medicine/healing went “underground”

9. 1970s Resurgence of interest in altern ther’s Chiropractic med took initiative along with osteopathic MDs Mainstream allopathic med continued to ignore alt med

10. 1993 & 1998 Eisenberg US Studies – “classic” in the field NEJM in ’93 nat’l phone survey to determine prevalence of use of “unconventional” therapies (ex: acu or chiro) Random sample of 1539 adults 16 commonly used interventions 1 in 3 persons used 1 or more U-therapies and 1/3 of these saw an U-therapy provider

11. 1993 Eisenberg US Study This 1/3 made 19 visits per year with avg cost of $27.60 per visit Use varied by SES: white, 25-49 yrs with hier educ & hier income leaders in usage Majority used U-th’s for chronic conditions 72% did not tell their MD about U-th visits Extrap to US pop means 425 million visits to alt med vs 388 mill to allo med in 1990

12. 98 Eisenberg JAMA follow-up from ’93 Used same process as 93, w 2055 adults Incr from 33 to 42 % in 97 – used herbal, massage, megavits, self-help groups, folk remedies, energy healing & homeopathy – chronic conditions A 47 % incr in use of alt med

13. 98 Eisenberg Incr was due to incr proportion seeking alt med, not to more visits by those already using alt med 629 million total visits by US pop to alt med practitioners in 97 Probably a $27 billion out-of-pocket on alt med in 97 thus equal to all out-of- pocket MD expenses in US

14. The Prevalence of CAM in Cdn Med Schools: 1998 CMAJ Study ’98 survey of all 16 Cdn med schools to determine what educ is provided re UG med ed in alt med Covered 18 comp therapies selected from Office of Alt Med, Nat’l Institutes of Health (acupunc to reflex) Most schools do teach alt med but in one course; done via lectures

15. 1998 CMAJ Study Most consistently taught are acupunc and homeopathic med (10 schools) Then, in descending order: herbal; chiro; naturop; TCM and biofeedback; osteopathy; shamanism, mass ther & therap touch; finally, yoga, aromatherapy, reflex and native trad healing – only 1 used spiritual healing

16. 1998 CMAJ Study Only 2 schools provide instruction in use of alt meds (yoga, mt, chiro) w most stating MD could seek tr by pref Schools felt they should provide general conceptual overview **Need to understand alt med as part of patients’ health care belief system Very little alt med tr in UK; most of US’s 125 med schools incorp some alt courses

17. Readings to Date Read for Module 1: Text chapters 1 & 3 1st reading on web site under Links, “Folk Remedies” (pdf) Print the Glossary of Terms from Links on web site Read for Module 2: Text chapters 2 & 4; read 2 for Thursday “Are you Considering Using CAM” from Links Irwin & Morrow article

18. Folk Remedies Among Ethnic Subgroups ~ reading “Folk medicine” in ’99 included ? Data source for the study ? Importance of individual’s cultural beliefs and practices ~ used Health Belief Model (HBM) to summarize these [ perceived benefit vs perceived threat factor in selecting health action]

19. Folk Remedies Among Ethnic Subgroups ~ commonalities: Understanding illness & making decisions about treatment action: ~ cause of illness an imbalance ~ emphasis on personal responsibility ~ complex, multicausal or holistic view of dis-ease etiology ~ various kinds of energy

20. Folk Remedies Among Ethnic Subgroups ~ interpretations: Findings re SES factors ? Effectiveness of Folk Rs ? Note problems of cost in study designs for effectiveness data *”lack of scientific evidence” - ? ?

21. Folk Remedies Among Ethnic Subgroups ~ clinical implics: Cultural beliefs MUST be considered Open communic betw clinicians and patients is critical Safety and efficacy of concern to both Major conclusion: “Folk medical practices arise out of the synergy of individual beliefs, cultural beliefs, and biomedical concepts about illness and treatment” Most folk remedies “harmless” – bias? And some “serious” side effects Note the recommendations to the Am Medical Assoc

22. Text – chapter 1: Basic Principles The Hippocratic Oath ~ Dr Louis Lasagna! “outdated, degrading, and inappropriate for the modern reality of medicine” ? Note distinctions betw holistic and reductionistic; Flexner Report; Heroic medicine; resurgence of traditional med Key factors etc in the concept of Integrative Medicine ~ any questions about those ?

23. Text – chapter 3: Mind-Body Medicine What is the essence or basic premise of M-B Med ? How has it become AND how is it integrative ? What are some examples of M-B Med ? What are the characteristics of M-B Med? What evidence do we have re M-B Med ? What can you interpret about M-B Med from the 4 cases presented in the chapter ?

24. Text Chapter 3: Mind-Body Med: 4 Primary Human Intelligence Systems Thought; Emotions; Body; Perceptions These 4 are congruent Means a change in one is mirrored in all others Just another way of looking at mind- body as more than an intellectual mind in a physical body

25. Behavioural Interventions: Asking Questions Coaching Example

26. For every winner, there are dozens of losers: odds are you’re one of them Defeat [ de-feet !]

27. The key to life is balance

28. Life Coaching Counselling, or therapy, often looks to the past in order to discover, heal and understand. Life coaching, on the other hand, looks to the future in order to make a good life even better. In coaching, the starting point is the client's desire for personal and /or professional change Coaching focuses on forwarding all aspects of the client's ordinary life toward an extraordinary life Coaching is not about how you came to be who you are; it's about getting you from where you are now to the future that you want

29. What we have in our lives _______________________________ -10 0 +10 MUST eliminate really, REALLY want

30. L I F E with Style Stress & Struggles Most fulfilling life possibilities ? ? ?

31. Client Coach Relationship

32. Co-Active Coaching: Either/or vs AND Co-active means acting in concurrence, united in action Co-active coaching like hiring a friend, having a personal navigator Fundamental skill in co-active coaching is

33. Fulfillment Process Balance Designed Alliance Curiosity Listening Intuition Action / learning Self-management Dance in the momentAgenda from client Whole life is involvedNRCW © The Coaches Training Institute The Co-Active Coaching Model ©

34. Evidence Base for Coaching ? Thousands of testimonials … Irwin-Morrow req’d reading What validates this model according to your reading ?

35. Fulfillment, Balance, & Process Person is always somewhere in her/his life and always in flow of that life Coach takes client somewhere juicy or rich or compelling, that is into: ~ Fulfillment, or ~ Balance, or ~ Process

36. ©The Bigger Game Company

37. The SIZE and quality of the game you play designs who you are becoming

38. So, what skills for coaching ? Listening Curiosity Intuition Forwarding into action / deepening athlete’s learning [ self management ] For the sake of what ? – living fully into the life each person wants

39. Coaching and CAM / Integration Coaching as an alternative for ‘healthy’ living, living into full human potential More a behavioural intervention than a therapy reading offers a way of providing evidence for efficacy of coaching Cannot do randomized, double-blind study We do need more ways to validate coaching